Westmont Magazine Exploring Effective, Ethical Treatment for the Mentally Ill
When he first heard about the killings at Virginia Tech in April, Jeff Swanson ’79 reacted with shock and horror. The father of two college students, he’s a university professor in a neighboring state. But he took more than a personal interest in the tragedy. Throughout his career as a medical sociologist, he has studied mental illness and violence, devoting his scholarly work to understanding such scenarios and seeking to prevent them.
One feature of the attack seemed significant: The shooter failed to comply with court-ordered mental health treatment. Whether or not to impose such care is a sharply debated topic, with some advocates arguing that people have the right to reject medication and therapy in the community.
“The mental health system didn’t reach out to him,” Jeff says. “People at the college knew he was disturbed, but they seemed helpless. Then he was able to buy two handguns, and the background check didn’t work as it should. It was the perfect storm where all the systems seemed to fail at once in the case of a very unwell young man in a dangerous state of mind.”
While few mentally ill people become violent, the ones who do receive tremendous publicity. “The public doesn’t pay much attention to mental health issues and policy, but they do care about personal safety,” Jeff says. “When this shooting happened, all these problems related to violence and untreated mental illness were suddenly the focus of an unbidden but overdue national discussion.”
Scholars and policy makers have discussed these issues for years; shortly before the massacre, Jeff spoke at the University of Virginia to help frame the debate over potential revisions to the state’s mental health statutes. He first studied the social dimensions of mental disorder and crime as a graduate student at Yale, where he earned his doctorate in sociology. He taught at the University of Texas Medical Branch, Galveston, for several years before completing a postdoctoral fellowship in mental health services and systems research at the University of North Carolina at Chapel Hill and Duke University Medical Center, a program he now co-directs. Duke recruited him to join the faculty in 1993; he’s a tenured, full professor in psychiatry and behavioral sciences.
A prolific scholar with more than 130 publications, Jeff has conducted numerous collaborative research projects on mental illness, violence, treatment and legal policy. He speaks frequently on these topics at national and international meetings. Federal and state government agencies, private foundations and pharmaceutical companies have funded his studies.
The son of a missionary doctor, Jeff grew up in Ecuador, where he saw how poverty and lack of access to health care affected illness. His background has inspired him to pursue an interdisciplinary approach to mental illness and to explore practical applications of academic research. “My studies focus on adults with severe mental illness, many of whom are poor, alone, homeless or in jail,” he says. “These are the outcasts of our society. I think developing more effective and responsible public policies to help them is a Christian thing to do. Part of this thinking relates to my missionary heritage.”
A tension exists between the rights of individuals with mental illness and the need to protect the public. To resolve this conflict, Jeff seeks to base the debate and the solutions on sound empirical evidence. He is engaged in a five-year research project funded by the National Institute of Mental Health, “Psychiatric Treatment and Violence Risk Management.” Another endeavor involves a three-year evaluation of the effectiveness of court-ordered outpatient treatment. He hopes his research leads to better public policy; ironically he finds that both sides quote his work.
Jeff says the psychiatric establishment has a long history of treating the mentally ill with paternalism and coercion. Many advocates for people recovering from mental illness now resist these approaches and seek greater personal autonomy. “The link between violence and mental disorder is a contested reality on the fault line between these camps,” he says. More than 490 publications cite his seminal 1990 paper on this topic.
Jeff’s research shows that long-term mandatory outpatient treatment can decrease incidents of violence. But he also studies psychiatric advance directives, new legal tools that allow people with mental illness to plan ahead for treatment during a future mental health crisis. With funding from the MacArthur Foundation, Jeff and his colleagues started the National Resource Center on Psychiatric Advance Directives (www.nrc-pad.org) and have worked with several states to pass legislation in this area.
College classes prepared him well for this work. “Academically, I had a great experience, getting to know professors personally whose main focus and passion was teaching,” Jeff says. “Some people say you forget all the facts you learn in college, but I remember quite a lot of them: I use statistical analysis all the time, the same equations I learned in Professor David Neu’s class. Last year, several colleagues and I collaborated on an article for the Journal of the American Academy of Psychiatry and Law about the ethics of doctors overriding patients’ psychiatric advance directives. I found myself summoning the memory of Professor Bob Wennberg’s lectures in ethics and the philosophy of the mind. I even fished out a couple of those old books he assigned— I still have them on my shelf alongside a few newer tomes.
“I remember Professor Ron Enroth talking about his own research on cults and new religious movements and his hate mail and threatening phone calls. I could see he was engaged as a thoughtful Christian scholar studying these difficult issues the best he could and accepting criticism — from all sides it seemed — with equanimity and grace, even good humor.”
But Jeff also struggled at Westmont as he made the transition from Ecuador to Santa Barbara. “I was far from home and felt isolated and disconnected,” he says.
Jeff lives in Chapel Hill, N.C., with his wife, Pamela, and three children. He attends Olin T. Binkley Baptist Church because of its inclusiveness and commitment to social justice issues.
Although he believes in basing policy recommendations on the evidence, Jeff notes that his research raises thorny questions that require moral judgments. He confronts these issues honestly and thoughtfully, determined to find practical ways to develop more effective and ethical responses to violence and mental illness.